Pythonic habitats

Confessing my guilt up-front about two things:

  1. It’s been a while since I wrote here. My best excuse (and it’s pretty true) is that the energy I might have spend blogging during the academic year was instead expended upon brief writing assignments for my graduate coursework. If you’re interested in any of my discussion topics from Indigenous Food Systems and/or Federal Indian Law & Policy, I can accommodate you. And with that nod, an acknowledgement that I have every intention to do better about sharing my thoughts with you starting now.
  2. Today’s title was intentionally chosen because this concept has captured my attention. No, there will not be gratuitous snake photos to accompany the post. I am not a fan of snakes. I am, however, a fan of the concept of pythonic habitats because they account for a not-uncommon phenomenon I’ve witnessed in academic medicine.

The amazing Dr. Mary Brandt referenced Rev. Larry Kent Graham’s book on moral injury in a recent talk she gave as part of the American College of Surgeons Leadership Summit. I was in the midst of preparing a grand rounds on well-being in surgery, so I promptly ordered the book because I had a sense it had important lessons to share. And, indeed, the link between moral injury and absence of well-being is almost undeniable.

A foundational section of the book discusses what Graham describes as the “four intersecting conditions” that give rise to trauma, with trauma defined to include moral injury. While all of the others- explosive assault, a road wrongly taken, and grievous loss- can seem intuitive, the words “pythonic habitats” made me sit up and notice differently. These “benign, constricted, and dangerous environments” slowly and inexorably “squeeze the life out of us.” He initially discusses relatively obvious pythonic habitats, in which people constantly live on the edge of situations that are a danger to life and health- there’s no single defining event, but instead a series of threats that require ongoing vigilance. Although Graham provided a more complex example of individuals with access to the nuclear triggers or who guide drone warfare, in which they do isolating work with moral consequences then go home to have dinner with their families, when he mentioned “benign normality” of their daily lives I immediately thought about the work that we do in medicine.

Think for a moment about the things that we do as part of our work caring for other human beings; surgeons, I’m particularly looking at us. When is the last time you had an experience caring for a patient that you can discuss quietly with a colleague- out of earshot of non-medical people- but wouldn’t dream of discussing over dinner at home? The reality is that we are witness to or actors in situations all of the time in our work that isolate us and that demand that we compartmentalize our lives. And somewhere along the way we all decide that it’s just business as normal because it’s what we have to do. Here’s a hint: it’s not normal, even though it may be necessary, and that causes moral dissonance for us.

Pythonic habitats struck me because while they are unavoidable in our profession, we generally don’t acknowledge their presence. We become the proverbial frog in the cold water that gets heated up until the water is at a boil, and the only escape tools we learn are those we see in the hidden curriculum; there’s little intention in how we all deal with this unrelenting constriction. Over time, unless we do consciously address it, that constriction takes a toll on our physical and mental health. And, as Dr. Jillian Horton states in her beautiful recent book We are all perfectly fine, “Most doctors look fine, perennially, until the day they don’t. That’s because doctors are excellent at compartmentalizing. We are also compliant and conscientious and rigidly perfectionistic, characteristics that put us at risk for choking to death on our own misery.”

I’m not going to profess to having a perfect solution for dealing with these pythonic habitats, though I am committed to seeking a remedy that will help to keep us whole. My hope is that by naming it- and acknowledging that it’s not normal- that at least gives us the possibility of moving towards recalibration and healing.